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Noticeof Dissolution CertifiedDate of Dissolution

Mail to:
IECDB
510 Eastl2tb,SuitelA
DesMoines,Iowa 50319
9o*nlrlee ( Lurr 6^ (brtoo^
Officlal Name of Commlttee

4aorfu*eruqfiz
Tpuelrrou1 Ja Ezgor/
City, State,Zip Code

tlbS 3?I _ e7t7

Area Telephone
Code

WHENTO FILE:
The Noticeof Dissolutionmust be fitedwithinthiay (30) daysof completionof alt the foilowlng:

1. All debts,loansand obllgations havebeenpaidortransfened;

2. All campaignfundshavebeenspent;
3. All campaignpropertysoldor fansfened (candldates only);and
4. A final reportdisclosingall bansactionsclosingthe committee.

For state candidatesand state PACs,a final bank statementmust be filed wFrhthe Noticeof Dissolutionor as soon as
possibleif the bankstatementis not availableat the time the Noticeof Dissolutionis filed.

of Chairor Treasurer(if pAC)

committee)/Signature

FORINSTRUCTONS,SEE BACK OF FORM

This form is not applicable to statutory polltlcal commlttees.